Provider Demographics
NPI:1285678961
Name:WOMENS HEALTH CARE OF NORTHERN KY PSC
Entity type:Organization
Organization Name:WOMENS HEALTH CARE OF NORTHERN KY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOCHOEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-331-4665
Mailing Address - Street 1:20 MEDICAL VILLAGE DRIVE
Mailing Address - Street 2:SUITE 354
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-331-4665
Mailing Address - Fax:859-331-6370
Practice Address - Street 1:20 MEDICAL VILLAGE DRIVE
Practice Address - Street 2:SUITE 354
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-331-4665
Practice Address - Fax:859-331-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933905Medicaid
0422Medicare ID - Type Unspecified